Rivers of ink have been spilled extolling both benefits and dangers of State-based acceptance of Medicaid as proposed under the Affordable Care Act. The facts, such as we know them at the time of this writing, are that 14 states have opted out of Medicaid expansion and, according to the Rand Corp. study released in June, stand to lose up to $8.4 billion in Federal funding in just one year as a result.
There is little argument that the Medicaid program is, at its best, a less-than-perfect health insurance program. Nonetheless, it is what we, as a country, have adopted to serve certain segments of our population.
Given the sheer numbers of our citizens who enjoy no health insurance, why on earth would we want more people to have some measure of insurance, flawed as it is? After all, don't the uninsured already have access to necessary health care by simply visiting the local emergency department? The expansion is expensive for states who adopt it, and what if, despite the financing guarantees built into the legislation, the Federal government steps back from its funding obligations in subsequent years? By expanding health insurance to more citizens, are we not simply moving down the path to a highly socialized single-payer (e.g., the Federal government) system? Do we want to expand the welfare state that access to Medicaid creates and promotes? Won't states be overwhelmed with the massive numbers of uninsured who will magically appear from the “woodwork?”
Given the sheer numbers of our citizens who enjoy no health insurance, why on earth would we not want more people to have some measure of health insurance, flawed as it may be? After all, those “free” visits to the local emergency department are not really “free”; the cost is simply shifted to those of us with insurance. Given the cost to all of us that inevitably accompanies the care we provide to people with chronic medical conditions, would you not think the access to health care that accompanies health insurance, and the education that accompanies it, would serve to reduce the incidence and prevalence of many chronic (read … very expensive) conditions? If the Federal government does indeed step back from its funding obligations under the legislation, does anyone really believe the various states are left helpless, without recourse? Don't they have representation in the two bodies that would be voting on such a default?
Of course, no one believes that the question of Medicaid expansion involves either politics or money. No one believes that any state legislator would vote against the expansion of Medicaid simply to obstruct implementation of the ACA. Everyone believes, rightly so, that this expansion is nothing more than a sinister plot by leftist leaning liberals to implement socialized medicine.
No one believes that many large employers pay their workers so little that they qualify for government-backed insurance at the taxpayer's expense.
Perhaps the question of expansion and the arguments for and against miss a fundamental, and far more important, question. Obstructionist politics and the evils of socialized medicine aside, what is our moral responsibility to our fellow citizens? Why are we so different from other civilized nations -- societies that have as a belief that their members have an obligation to each other rather than a belief that individuals are only responsible for themselves? Shouldn't that be the question?

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